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Thinking about stakeholder risk and accountability in pilot experiments

Heather Lanthorn's picture

ACT malaria medicationHeather Lanthorn describes the design of the Affordable Medicines Facility- malaria, a financing mechanism for expanding access to antimalarial medication, as well as some of the questions countries faced as they decided to participate in its pilot, particularly those related to risk and reputation.

I examine, in my never-ending thesis, the political-economy of adopting and implementing a large global health program, the Affordable Medicines Facility – malaria or the “AMFm”. This program was designed at the global level, meaning largely in Washington, DC and Geneva, with tweaking workshops in assorted African capitals. Global actors invited select sub-Saharan African countries to apply to pilot the AMFm for two years before any decision would be made to continue, modify, scale-up, or terminate the program. One key point I make is that implementing stakeholders see pilot experiments with uncertain follow-up plans as risky: they take time and effort to set-up and they often have unclear lines of accountability, presenting risk to personal, organizational, and even national reputations. This can lead to stakeholder resistance to being involved in experimental pilots.

It should be noted from the outset that it was not fully clear what role the evidence from the pilot would play in the board’s decision or how the evidence would be interpreted. As I highlight below, this lack of clarity helped to foster feelings of risk as well as a resistance among some of the national-level stakeholders about participating in the pilot. Several critics have noted that the scale and scope and requisite new systems and relationships involved in the AMFm disqualify it from being considered a ‘pilot,’ though I use that term for continuity with most other AMFm-related writing.
 
In my research, my focus is on the national and sub-national processes of deciding to participate in the initial pilot (‘phase I’) stage, focusing specifically on Ghana. Besides being notable for the project scale and resources mobilized, one thing that stood out about this project is that there was a reasonable amount of resistance to piloting this program among stakeholders in several of the invited countries. I have been lucky and grateful that a set of key informants in Ghana, as well as my committee and other reviewers, have been willing to converse openly with me over several years as I have tried to untangle the reasons behind the support and resistance and to try to get the story ‘right’.

Blog post of the month: Cycling is everyone’s business

Leszek J. Sibilski's picture

This post is also available in French and Spanish .
“I’ve seen some of the highest performance bicycles in the world, but I believe the most powerful bicycle is the one in the hands of a girl fighting for her education, or a mother striving to feed her family.” 
- F.K. Day, Founder of World Bicycle Relief

  
The rainbow jersey, Giro d’Italia, Tour de France, or Vuelta a Espana—that’s what usually comes to mind when we think of cycling. However, elite cycling is only one small spoke of a much larger wheel.
 
By some estimates, there are already more than two billion bikes in use around the world. By 2050, that number could be as high as five billion. Over 50 percent of the human population knows how to ride a bike. In China, 37.2 percent of the population use bicycles. In Belgium and Switzerland, 48 percent of the population rides. In Japan, it is 57 percent, and in Finland it’s 60 percent. The Netherlands holds the record as the nation with the most bicycles per capita. Cyclists also abound in Norway, Sweden, Germany, and Denmark. The Danish capital, Copenhagen, is considered the most bicycle-friendly city in the world. It’s known as the “City of Cyclists,” where 52 percent of the population uses a bike for the daily commute. Bicyclist commuters are generally healthier than those who drive motor vehicles to work. They also remain unaffected by OPEC decisions about crude oil production or the price per barrel.
 
Due to the size of China’s population, and the need for bicycle transportation, statistics on the country’s bikeshare program are staggering. In a database maintained by Russell Neddin and Paul DeMaio, more than 400,000 bikeshare bikes are used in dozens of cities on the Chinese mainland, and the vast majority of those bikes have been in operation since 2012.  There are an estimated 822,000 bikeshare bikes in operation around the world. China, therefore, has more bikeshare bikes than all other countries combined. The country with the next-highest number of bikes is France, which has just 45,000.

Why do sanitation campaigns fail?

Suvojit Chattopadhyay's picture

The study finds that the govt’s rural sanitation programme, implemented by NGOs, was unable to reduce exposure to faecal matter.

A recently published Lancet paper looks at the impact of the erstwhile Total Sanitation Campaign in the coastal Puri district in Odisha. The study finds that the government’s rural sanitation programme, implemented by NGOs and community-based organisations, was unable to reduce exposure to faecal matter. As a result, this sanitation programme had no impact on the incidence of diarrhoea and malnutrition. The authors of the paper conclude that in order to realise concrete and sustainable health benefits, sanitation programmes need to increase both the coverage and use of toilets, as well as improved hygienic practices.

No one denies the importance of good sanitation and the impact it has on human health. It must follow therefore that the lack of positive impact is down to poor implementation of the sanitation programme in the study area. In fact, a process evaluation of the programme concludes that the implementation was far from perfect, both in terms of the levels of coverage achieved and the levels of awareness. Over an implementation period of 13 months (January 2011—January 2012), the villages where the programme was implemented saw an increase in toilet coverage from 9% to 63%, but only 38% of the households had a functional toilet. It would have been interesting to learn more about the gap between toilet construction and usage (25 percentage points). In any case, the state of implementation, the authors point out, is typical of the prevalent Total Sanitation Campaign across the country.
 

The false dichotomy among sanitation-for-all advocates

Suvojit Chattopadhyay's picture

The sanitation debate has suffered from a seemingly irreconcilable dichotomy when it comes to identifying the best approach towards sanitation for all.

A good way of blocking progress in an argument is to present two aspects of a whole as a dichotomy. The sanitation debate, in recent years, has suffered from a seemingly irreconcilable dichotomy when it comes to identifying the best approach towards sanitation for all. This is the one that pits subsidies against motivation and correspondingly, construction against behaviour change communication. And yet, in a comprehensive and prudent programme design, there is no need for these ideas to be opposed to each other. I call this then, the false dichotomy in the world of sanitation advocates.

The current sanitation programme in India has at its centre a subsidy and incentive for individual households constructing toilets. This is a programme that has clearly not worked, irrespective of the minister or bureaucrat at the helm of affairs. India holds the ignominious record of having the largest number of people defecating in the open. At the same time, the popularity of the community-led total sanitation (CLTS) approach has risen. This approach depends on using shame and motivate as a call to action to build basic pit latrines (rejecting subsidies completely) and has worked in multiple countries around the world, as well as in certain states in India.
 

Weekly Wire: The Global Forum

Roxanne Bauer's picture

These are some of the views and reports relevant to our readers that caught our attention this week.

 
Africa in 2030: drones, telemedicine and robots?
The Guardian
In 2000 the CIA’s national intelligence council made a series of pessimistic predictions about Africa. They suggested that sub-saharan Africa would become “less important to the international economy” by 2015; that African democracy had gone “as far as it could go”; and that technological advances would “not have a substantial positive impact on the African economies.”  Clearly, predictions don’t always come true. Between 2000 and 2012, the number of mobile connections in Africa grew by 44%. In 2011, mobile operators and their associated businesses in Africa has a “direct economic impact” of $32bn, and payed $12bn in taxes. It made up 4.4% of sub-Saharan Africa’s GDP, according to a 2012 report.  But the advances in communications are not the only element defining Africa’s future:
 
Good Governance: Well-Meaning Slogan Or Desirable Development Goal?
Forbes
Corruption last year cost the world more than one trillion dollars. That is a trillion dollars we can’t use to get better health care, education, food and environment. And corruption is only part of the problem of poor governance – many countries are run ineffectively, lacking accountability, transparency and rule of law.  Running countries better would have obvious benefits. It would not only reduce corruption but governments would provide more services the public wants and at better quality. It is also likely that economic growth would increase. In a recent UN survey of seven million people around the world, an honest and responsive government was fourth in the list of people’s priorities, with only education and healthcare and better jobs being rated higher.  But how should we get better governance?

Cycling Is Everyone’s Business

Leszek J. Sibilski's picture

This post is also available in French.
“I’ve seen some of the highest performance bicycles in the world, but I believe the most powerful bicycle is the one in the hands of a girl fighting for her education, or a mother striving to feed her family.” 
- F.K. Day, Founder of World Bicycle Relief

  
The rainbow jersey, Giro d’Italia, Tour de France, or Vuelta a Espana—that’s what usually comes to mind when we think of cycling. However, elite cycling is only one small spoke of a much larger wheel.
 
By some estimates, there are already more than two billion bikes in use around the world. By 2050, that number could be as high as five billion. Over 50 percent of the human population knows how to ride a bike. In China, 37.2 percent of the population use bicycles. In Belgium and Switzerland, 48 percent of the population rides. In Japan, it is 57 percent, and in Finland it’s 60 percent. The Netherlands holds the record as the nation with the most bicycles per capita. Cyclists also abound in Norway, Sweden, Germany, and Denmark. The Danish capital, Copenhagen, is considered the most bicycle-friendly city in the world. It’s known as the “City of Cyclists,” where 52 percent of the population uses a bike for the daily commute. Bicyclist commuters are generally healthier than those who drive motor vehicles to work. They also remain unaffected by OPEC decisions about crude oil production or the price per barrel.
 
Due to the size of China’s population, and the need for bicycle transportation, statistics on the country’s bikeshare program are staggering. In a database maintained by Russell Neddin and Paul DeMaio, more than 400,000 bikeshare bikes are used in dozens of cities on the Chinese mainland, and the vast majority of those bikes have been in operation since 2012.  There are an estimated 822,000 bikeshare bikes in operation around the world. China, therefore, has more bikeshare bikes than all other countries combined. The country with the next-highest number of bikes is France, which has just 45,000.
 

Technology Alone Will Not Save the World: Lessons from the 2015 Gates Letter

Suvojit Chattopadhyay's picture

Melinda and Bill Gates have made an annual tradition of publishing their thoughts on international development and its key challenges. Given the substance, I assume these letters reflect an annual manifesto for the organisation they head, the Bill and Melinda Gates Foundation (BMGF). Last year, I wrote about how the Gates Annual Letter was disappointing, perhaps not in the context of what the BMGF itself does, but what it ought to be doing, given its $42 bn muscle and its influential promoter, Bill Gates.

This year, the letter makes four “big bets” for 2030: child deaths will go down by half, and more diseases will be eradicated than ever before; Africa will be able to feed itself; mobile banking will help the poor radically transform their lives; and better software will revolutionise learning. In short, fast-tracking the identification ­technological fixes and expanding their reach over the next fifteen years will deliver a better world.

Unfortunately, these bets seem to me to be wildly optimistic. I may be quibbling, but from what we have learnt from research, there seem to be many reasons to suggest that we should be cautious with our optimism regarding what we can achieve with technology. The complexities of working on power, politics and implementation find no mention in the letter. Let us look a little more closely at each one of the bets to find out why that matters so much.

Blog Post of the Month: Quest For Green, Clean, and True Sport For All

Leszek J. Sibilski's picture
Each month People, Spaces, Deliberation shares the blog post that generated the most interest and discussion.

In January 2015, the leader of the pack was Leszek Sibilski's post, "Quest For Green, Clean, and True Sport For All", which covers the corruption of international sport.

Leszek elaborates that, "Due to its size and global reach, two types of corruption plague contemporary sport:
  1. On-the-field corruption by athletes, team officials, referees, and the entourage, for example through hooliganism, doping, and match fixing; and
  2. Off-the-field corruption by sport managers, sponsoring organization officials, and operators through, for example, bribed decisions, rigged contracts, misuse of authority, influence peddling and insider information."

He believes that "both types of corruption are detrimental to the integrity of sport and create unacceptable situations for states and society at large, including money laundering, kickbacks, illegal betting, public health issues, and human trafficking."

So what can be done to alleviate this problem?  Read the post to find out!
 

Campaign Art: A Hair-Raising Message

Roxanne Bauer's picture
People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

In February 2014, a Swedish shampoo advertisement blew people away in Stockholm subways. The electronic ads were equipped with sensors to recognize a train’s arrival at the station. Each time a train appoached, the models' hair blew around, giving the impression that they were windswept.

More recently, Garbergs, a Swedish media agency, developed their own take on the ad for The Swedish Childhood Cancer Foundation (Barncancerfonden) but with an unexpected twist that left observers a little stunned. 
 
VIDEO: A hair-raising message

Quest For Green, Clean, and True Sport For All

Leszek J. Sibilski's picture
“Sport has the power to change the world… it has the power to inspire. It has the power to unite people in a way that little else does. It speaks to youth in a language they understand. Sport can create hope where once there was only despair. It is more powerful than government in breaking down racial barriers.”
- Nelson Mandela
 
I was not surprised by the reaction of the readership to my last blog on sustainable, addiction-free, fair, and ethical sport for all. I expected that the World Bank Group’s international community would react to the topic, knowing how important sport is for many of us —and I decided to expand the discussion. Here, I’d like to elaborate further on corruption in an international industry that captures the attention of billions of people, employs millions, and according to a recent A.T. Kearney study, generates $700 billion yearly, or one percent of global GDP. "With seven percent per year growth between 2009 and 2013, the sport market has grown faster than the GDP in most countries in the world, especially in major markets including the United States, Brazil, the UK, and France." It’s imperative we clean up sport now.
 
Due to its size and global reach, two types of corruption plague contemporary sport:
  1. On-the-field corruption by athletes, team officials, referees, and the entourage, for example through hooliganism, doping, and match fixing; and
  2. Off-the-field corruption by sport managers, sponsoring organization officials, and operators through, for example, bribed decisions, rigged contracts, misuse of authority, influence peddling and insider information.

Both types of corruption are detrimental to the integrity of sport and create unacceptable situations for states and society at large, including money laundering, kickbacks, illegal betting, public health issues, and human trafficking.

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